30 ANNUAL SCIENTIFIC MEETING 2014/
The British Associatonof Aesthetic Plastic SurgeonsANNUALSCIENTIFICMEETING2014/LONDON30THThe Queen Elizabeth II Conference Centre25-26 September PS 2014 Platinum Sponsor
THE BRITISH ASSOCIATONOF AESTHETIC PLASTIC SURGEONS30 ANNUAL SCIENTIFIC MEETINGTH2014/LONDONContentsProgramme and Live Demonstration TheatreThursday 26 September4Friday 27 September5Sponsors7Abstracts8Posters23Faculty Biographies33Social Programme37Trade Exhibitors38Exhibition Plan39Trade Exhibitor Company Contacts40BAAPS Factsheets41BAAPS CouncilPresidentMr Rajiv GroverImmediate Past PresidentMr Fazel FatahVice PresidentMr Michael CadierHon SecretaryMr Paul HarrisHon TreasurerMr Neil McLeanMembersMr Kevin HancockMr Mark HenleyMr James McDiarmidMr Douglas McGeorgeMr Ash MosahebiMr Nigel MercerMr Charles NdukaMr Graham OfferMr Ken StewartMr Simon WitheyCME PointsThursday 26 September5.5Friday 27 September63
BAAPS 2014PROGRAMMETHURSDAY 25th September08.1508.5009.0009.00REGISTRATIONWelcome Rajiv GroverLECTURE SESSION Chairs: Ash Mosahebi & Charles NdukaFacial soft tissue anatomy and methods to avoid facial nerve complicationsin facelifting09.30Rationale and myths around the use of polyurethane covered breast implantsLiveDemonstrationTheatreJames StuzinAlexis Verpaele10.00Definitive treatment for recurrent capsular contracture utilizing regenerativeconstructsPatrick Maxwell10.3011.0011.00COFFEE BREAK & TRADE EXHIBITIONFREE PAPERS & LECTURE Chairs: Paul Harris & Simon WitheyPerfecting the outcome of endoscopic browlift part two – closing the audit loop11.10Competition in aesthetic surgery arena: plastic surgeons remain at thecutting edgeDan Marsh10.40 – 11.00NagorPaul BaguleyBreast augmentationand mastopexy – analternative approachRoisin Dolan11.20Submandibular and parotid gland reduction in facelift surgeryFrancisco Bravo11.30A pilot study to assess the feasibility and acceptability of using a psychologicalscreening tool in private cosmetic practice11.40Report on the BAAPS Travel Fellowship: The Australian Craniofacial UnitNicole ParaskevaFateh Ahmad11.50Fighting fat: adipose derived stem cell sub population selection forsupercharged autologous fat graftingKavan Johal12.00Bioengineered Breasts: the next generation of breast enhancementPatrick Maxwell12.3013.4013.40LUNCH AND TRADE EXHIBITIONPRACTICE MANAGEMENT SYMPOSIUM & VIDEO PRESENTATIONChairs: Neil McLean, Graham Offer, James McDiarmidCosmetic surgery claims: the PRASIS experienceGerard Panting14.00Protecting your online reputationMagnus Boyd14.20Online behaviour for surgeons14.40BAAPS: its gestation and Mike Hackett - ‘a one-off’Tingy SimoesDai Davies15.0013.00 – 13.20NagorProf. Franck DuteilleOngoing 10-yearclinical study – safetyfor Eurosilicone’s roundand anatomimicalsilicone gel breastimplants – 5 yearpublished resultsRevisionary augmentation mastopexy – VIDEO PRESENTATIONPatrick Maxwell15.3016.00TEA BREAK AND TRADE EXHIBITIONKEYNOTE ADDRESS: Chair: Rajiv GroverThe evolution of breast aesthetics: a 30-year personal journeyPatrick Maxwell16.45ENDDRINKS RECEPTION AND CONFERENCE DINNERThe Members’ Terrace and Dining Room – Palace of Westminster415.40 – 16.00Surface ImagingSolutionsNicholasMiedzianowski-SinclairThe X,Y Z factor inaesthetic surgery
30TH ANNUAL SCIENTIFIC MEETING - LONDONFRIDAY 26th September08.5009.0009.00Welcome Rajiv GroverLecture Session Chairs: Simon Withey & Douglas McGeorgeThe ten commonest problems in rhinoplasty and how to avoid them09.30Introduction to the National Institute of Aesthetic ResearchLiveDemonstrationTheatreCharles EastSir Bruce Keogh - National Medical Director, NHS Englandand Healing Foundation Trustee09.40The BAAPS/HF National Institute of Aesthetic ResearchBrendan Eley09.50Fifty shades of SMAS: matching the facelift operation to the patientRajiv Grover10.2010.5010.50COFFEE BREAK AND TRADE EXHIBITIONLecture Session Chairs: Ash Mosahebi & Michael CadierEvidence based medicine in aesthetic surgeryFoad Nahai11.15Continuum of facial rejuvenation: when to transition from non-surgical tosurgical treatment10.20 – 11.00ZeltiqJennifer HarringtonCoolSculpting: clinicaloutcomes to ensurecommercial successAlexis Verpaele11.45BAAPS KEYNOTE ADDRESS: Chair: Rajiv GroverMy 30 year journey to understanding facial aging and its relevance to faceliftingJames Stuzin12.3013.1513.4513.45LUNCH AND TRADE EXHIBITIONAGMKEYNOTE LECTURE & SPONSORED PRESENTATIONChairs: Michael Cadier & Neil McLeanBAAPS KEYNOTE ADDRESS:Eliminating our blind spots in facial rejuvenation surgeryAlexis Verpaele14.3015.0015.00CoolSculpting: don’t settle for anything less than the bestJennifer Harrington - SPONSORED PRESENTATIONFREE PAPERS Chairs: Paul Harris & Simon WitheyThe Aston Facelift – a step by step guideFulvio Urso-Baiarda15.10Measuring outcomes using Patient Reported Outcome Measures (PROMs)in aesthetic practice – a UK experienceAli Soueid15.20Open neck-lift: a fusion of elasticity and empiricism15.30A comparative analysis of the efficacy of the Fulcrum Spreader graftcompared to the Sheen Spreader graftIvo Gwanmesia15.4016.10TEA BREAK AND TRADE EXHIBITIONINTERACTIVE OPERATIVE VIDEO SESSIONChairs: Fazel Fatah & Kevin HancockMicrofat, SNIF and Nanofat: harvesting and injection technique –Muhammad Adil Abbas Khan16.10Alexis Verpaele - VIDEO PRESENTATION16.40The essential technical element to successfully preforming an extendedSMAS facelift –James Stuzin - VIDEO PRESENTATION17.00Essential pearls in cervical rejuvenation17.20PRESENTATION OF PRIZES AND CLOSE OF MEETING Chair: Rajiv GroverJames Stuzin - VIDEO PRESENTATION5
30TH ANNUAL SCIENTIFIC MEETING - LONDONMAJOR SPONSORSBAAPS gratefully acknowledges the support of the trade exhibitors – without whom this event would not be possible.Platinum SponsorGold SponsorsSilver SponsorsPoster Exhibition7
BAAPS 2014ABSTRACTS1Facial soft tissue anatomy and methods to avoid facial nervecomplications in faceliftingPresenterJames StuzinInstitutionMiami, FloridaThis presentation will discuss the architectural arrangement of facial soft tissue, emphasizing threedimensional concepts to avoid facial nerve complications in face lifting. Danger zone areas for eachnerve branch will be discussed, as well as technical methods to avoid motor branch injury withinspecific regions of the cheek will be examined. Methods to avoid nerve injury in subSMAS dissectionwill similarly be discussed.2Rationale and myths around the use of polyurethane covered breastimplantsPresenterAlexis VerpaeleCo-authorPatrick TonnardInstitutionCoupure Centrum, GentBackgroundIn the choice of breast implants for both aesthetic and reconstructive augmentation there has everbeen a struggle between aesthetic appearance and natural feeling on the one hand, and safety on theother hand. After many types of implant shells and contents the Micro PolyUrethane Covered SiliconeGel implant proves its unmatched safety and pleasing results. A review of the history concerning thesafety of these implants is given. The comparison is made between the outcome of texturedinflatable, textured gel and PU covered gel implants.MicroPolyurethane covered Silicone (“MPS”) breast implants have been used in our practice for 15years, of which 11 years exclusively. The very low incidence of implant related revisions combined witha good potential for predictable cosmetic outcome are strong arguments for this implant policy.Nevertheless some complications occurred during our experience, of which most were not implantrelated.MethodsA total of 1253 patients received MPS implants for cosmetic breast correction. 921 patients (76%)were either followed-up regularly or recently contacted per telephone and queried for satisfaction,complications and possible other breast procedures undergone elsewhere.ResultsFollow-up ranged from 1-15 years, with an average of 6.8 years. 78% of the procedures were purebreast augmentations, 22% received a concomitant mastopexy.75 % of implants were anatomical, 24 % round and 1% conical. The majority (64%) were placed in aretropectoral position, 32% in a subfascial position and 2% in a pure retroglandular position.The total incidence of reoperations was 6,8%, of which the vast majority were non-implant related.Implant related complications leading to reoperations were late seroma (3 patients), capsularcontracture Baker IV (1 patient), and late implant rupture (3 patients).Surgery related reasons for reoperation included implant malpositioning (8), asymmetry (3) ptosis (5),implant palpability/folds (9 patients), haematoma (11), hypertrophic/widened scars (6), and uponpatient’s request (14).Conclusion15 years of experience with MPS implants confirms our conviction that these implants allow thesurgeon to predictably create aesthetically pleasing breasts, with an incidence of reoperation which issignificantly lower than non-MPS implants. The advantages outweigh the disadvantages.8
30TH ANNUAL SCIENTIFIC MEETING - LONDON3Definitive treatment for recurrent capsular contracture utilizingregenerative constructsPresenterPatrick MaxwellInstitutionMaxwell Aesthetics, Nashville, USACircumferential capsular contracture around silicone prosthetic breast implants has remained one ofplastic surgery’s most vexing problems. While various theories as to its etiology have been addressed,and perhaps an overall reduction in its occurrence has been somewhat improved with “best practiceprinciples”, its ablation, especially in repeated, recurrent cases, remains a major problem in women’shealth. Past concepts, still utilized by some today, attempt to alter the orientation of the collagen fibrils inthe foreign body capsular response to the breast implant. Such technologies include textured siliconesurfaces and foam surface coverings of the implant shell. Long term outcomes and safety concerns ofthe latter remain regulatory problems. The use of regenerative scaffolds, composed of preciselyprocessed acellular dermal matrices have been shown to be accepted by the recipient host as “self”rather than “foreign body”. Thus the body’s response to these materials is one of the natural, regenerativehealing rather than foreign body scar formation. This response is characterized by revascularization andcellular repopulation. When this regenerative scaffold is placed in intimate engagement with the shell of abreast implant, foreign body capsule formation does not occur, thus circumferential capsular contractureis not possible. This scientific basis and world’s largest clinical experience of this concept will bepresented.4Perfecting the outcome of endoscopic brow lift part two - closing theaudit loopPresenterDan Marsh, SpR London DeaneryCo-authorsMr S Lo, Mr B JonesInstitutionKing Edward VII Hospital, LondonObjectives1. To determine the longevity of brow position post browlift2. To assess the effect on brow shape with a revised technique placing the fixation point more laterallyMethodEndoscopic brow lifting was assessed in two groups of patients. Group 1 consisted of 31 patients with5.4 year follow up, with a standardized cortical fixation above the lateral limbus. Group 2 consisted of 17patients with a revised technique to place the fixation more laterally. Brow heights were measured withFacegram software, and aesthetic outcomes with validated scoring scales.ResultsBrow elevation is retained at 5.4 years post browlift along the whole brow except at the most lateralportion (p 0.001), where elevation relapsed to pre-operative levels. To address this, the operativetechnique was revised in the second group of patients, moving the brow fixation point laterally. Thisrevised technique resulted in lateral brow elevation of 4.2mm compared to the standard technique of1.1mm (p 0.001).ConclusionsThis study demonstrates that a significant elevation in brow height remains at 5.4 years after brow liftexcept at the most lateral part of the brow. This weakness can be addressed by using a revised techniqueplacing the point of brow fixation more laterally.9
BAAPS 2014ABSTRACTS5Competition in the aesthetic surgery arena: plastic surgeons remain atthe cutting edgePresenterRoisin Dolan, SpRCo-authorsProfessor J Zins, Mr C MorrisonInstitutionSt. Vincent’s University HospitalBackgroundWith advances in technological innovation, increased sub-specialization, and a shift towards evidencebased practice, the aesthetic surgery arena is a competitive marketplace for users and providers alike.Despite our unique innovative qualities, are plastic surgeons losing ground? The aim of this study is toanalyze the publication patterns for common aesthetic procedures and assess competition in theaesthetic surgery practice by analyzing the quality and quantity of the contributions from our sisterspecialties.MethodsBased on the American Society for Aesthetic Plastic Surgery annual statistics for 2013, the top 5commonly performed aesthetic surgical procedures were selected. A search strategy for the Web ofScience database was devised, using MeSH defined terms for these procedures. A temporal analysisof publication and citation rates, source institution and country, publishing journal, funding agencytrends and level of evidence were analyzed from 1945 to 2013.ResultsSeven thousand three hundred and twenty five articles (n 7,325) were identified using the searchcriteria. There was a 50-fold increase in publication rates comparing the first decade (n 61) to the lastdecade (n 3021). The top 5 plastic surgery journals published 38.5% of the total aesthetic literature.Over the past decade, 62.9% (n 1900) of publications and 87% of Level I evidence in the aestheticsurgery literature were authored by plastic surgeons.ConclusionsDespite increased competition by our sister specialties, plastic surgeons continue to lead in the field ofaesthetic surgery in quantity and quality of their contributions to the literature.6Submandibular and parotid gland reduction in facelift surgeryPresenterFrancisco BravoInstitutionClinica Gomez Bravo, SpainBackgroundPatients with thick and heavy necks seeking improvement of their jawline and cervicomental anglemay present with hypertrophied salivary glands. The purpose of this study is to evaluate the benefit ofreducing the submandibular and/or parotid glands in order to achieve improved results in patientsundergoing facelift surgery.Methods27 consecutive facelift patients (21 female, 6 male) were evaluated in regards to the treatmentperformed on either their submandibular or parotid glands. 23 of these patients had glandularreduction at the time of their facelift procedure, with 56 salivary glands being partially resected.Submandibular gland reduction was performed through a submental approach. Partial parotid glandresection superficial to the facial nerve was performed through a periauricular facelift approach in allcases. Patients were followed for a minimum of one year.10
30TH ANNUAL SCIENTIFIC MEETING - LONDONResultsTwo patients presented a sialocele in the submandibular region after submandibular gland reduction atone week postoperatively. Both of them required transcutaneous drainage in the office.ConclusionsParotid and submandibular gland reduction through the use of partial resection techniques is a safe andreliable procedure and may be considered a significant adjunct for maximum contour control in selectedface and necklift surgery patients.7A pilot study to assess the feasibility and acceptability of using apsychological screening tool in private cosmetic practice.PresenterNicole ParaskevaCo-authorsProfessor N Rumsey, Professor A ClarkeInstitutionUniversity of the West of EnglandBackgroundPatients typically seek cosmetic surgery for psychological reasons. Psychological assessment prior to acosmetic procedure is the exception rather than the norm. Responding to the imperative to develop anacceptable method for the routine screening and audit of patients seeking and undergoing cosmeticprocedures within the private sector, the authors have developed an instrument, the ‘RoFCAR’, designedto fulfil these functions.MethodsA pilot study involving 42 patients presenting for cosmetic surgical procedures was conducted to assessthe feasibility and acceptability of routinely implementing the RoFCAR was conducted in four privatepractices across the UK. In addition, semi-structured interviews were conducted to explore the views ofaesthetic surgery providers in relation to implementing the questionnaire.FindingsAnalysis of interviews confirmed that the RoFCAR was quick for patient’s to complete. The questionswere deemed appropriate and no patients reacted negatively to completing the screening tool. Methodsfor implementing the RoFCAR varied depending on the practice. Minor refinements were made to theRoFCAR based on the findings from the interviews.DiscussionThe acceptability and utility of the RoFCAR will be discussed along with the initial results of a largerscale, multi-site feasibility and acceptability study currently being conducted in the private sector (n 830).8Report on the BAAPS Travel Fellowship: The Australian CraniofacialUnitPresenterFateh AhmadInstitutionAustralian Craniofacial UnitI was awarded a BAAPS Travelling Fellowship on the basis of my stated aim to gain experience in themanagement of facial deformity and aesthetic refinements in craniofacial surgery.I was fortunate enough to be appointed to the renowned craniofacial fellowship at the AustralianCraniofacial Unit under the tutelage of Professor David David for a period of one year.Having completed a craniofacial fellowship in Birmingham, I consolidated my existing knowledge in themanagement of craniosynostosis in Adelaide, where I also learnt important and transferrable skills inmanaging facial fractures, craniofacial access, facial and skull base tumours and orthognathic surgery. Iwas taught from first principles, including planning and execution of these procedures. I also gained11
BAAPS 2014ABSTRACTSvaluable experience in ‘latter years surgery’ in craniofacial and cleft patients that included inlay/onlaybone grafting, facelifts, eyelid surgery, rhinoplasty, fat transfer, bimaxillary surgery and genioplasty. Allsurgery was closely supervised by experienced craniofacial surgeons.With regular case write-ups and tutorials from renowned teachers and trainers, the educationalcomponent of the fellowship was addressed. These included weekly one-to-one teaching withProfessor David. The plethora of research material afforded ample opportunity to write research papers.In all, the year spent in Adelaide was an intense and highly rewarding period of my training and I thankBAAPS for assisting me in this endeavour.9Fighting fat: adipose-derived stem cell sub-population selection forsupercharged autologous fat graftingPresenterKavan Johal, BAAPS / Healing Foundation Research FellowCo-authorsProfessor V Lees, Mr A ReidInstitutionUniversity of Manchester/University Hospital South ManchesterIntroductionDespite clinical refinement of fat grafting procedures patient results remain limited by variable survivalof transplanted fat. Supplementation with adipose-derived stem cells (ASCs) selected for graftenhancing properties may be of benefit.MethodsPrevalence of the surface markers CD24 and CD34 in the stromal vascular fraction (SVF) of humanmixed(M), superficial(S), and deep(D) adipose tissue was determined, prior to flow cytometry selectionof sub-populations by these markers for in vitro proliferation and adipogenic assays. Steps to facilitateclinical translation (cell cryopreservation, non-enzymatic digestion techniques, serum-free culture andsubcutaneous biopsies to harvest ASCs) were tested.ResultsMean prevalence of CD34 within SVF was M 55%, S 69%, D 42%; and of CD24 M 5.75%,S 4.4%, D 6.6%. CD34 cells demonstrated improved proliferation versus unsorted populations(P 0.001) and adipogenic preference as shown by qPCR (PPAR?, FABP4) and ELISA (leptin); howeverthe reverse was seen for CD24 . Mixed(M) ASCs proliferated fastest,
Method Endoscopic brow lifting was assessed in two groups of patients. Group 1 consisted of 31 patients with 5.4 year follow up, with a standardized cortical fixation above the lateral limbus. Group 2 consisted of 17 patients with a revised technique to place the
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